MEDICARE: MS. JEANNE O'MALLEY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-00809	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043217680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE O'MALLEY PT

Provider Business Mailing Address
First Line	:	20370 LORAIN RD
Second Line	:
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-3411
Country	:	US
Telephone Number	:	440-356-3213
Fax Number	:	440-331-0453

Provider Business Practice Location Address
First Line	:	20370 LORAIN RD
Second Line	:
City	:	FAIRVIEW PARK
State	:	OH
Zip	:	44126-3411
Country	:	US
Telephone Number	:	440-356-3213
Fax Number	:	440-331-0453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/21/2014

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